Provider Demographics
NPI:1336109644
Name:DAVID J. HAYS
Entity Type:Organization
Organization Name:DAVID J. HAYS
Other - Org Name:ANNVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS. BILLING CREDENTIALING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:606-843-6195
Mailing Address - Street 1:2659 NORTH LAUREL ROAD
Mailing Address - Street 2:P O BOX 495
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0000
Mailing Address - Country:US
Mailing Address - Phone:606-843-6195
Mailing Address - Fax:606-843-6222
Practice Address - Street 1:95 SR 3444 HWY
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402-0398
Practice Address - Country:US
Practice Address - Phone:606-364-5162
Practice Address - Fax:606-364-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100071750Medicaid
KY7100071750Medicaid
01148Medicare PIN
KY183955Medicare Oscar/Certification